Provider Demographics
NPI:1760730139
Name:MOORE, DANA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63780-1227
Mailing Address - Country:US
Mailing Address - Phone:573-576-7056
Mailing Address - Fax:
Practice Address - Street 1:1349 N MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-1727
Practice Address - Country:US
Practice Address - Phone:573-334-9564
Practice Address - Fax:573-334-1879
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012022143363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily